Does the Prone Position During the Shockwave Lithotripsy of Kidney Stones Improve the Stone-Free Rate? Results from a Randomized Clinical Trial
Urology Journal,
Vol. 20 (2023),
,
Page 7418
https://doi.org/10.22037/uj.v20i.7418
Abstract
Objective: This study aimed to evaluate the impact of the skin-to-stone distance in the supine and prone positions on the outcome of shockwave lithotripsy of kidney stones.
Methods: In a prospective randomized clinical trial study, 81 patients that candidates for shockwave lithotripsy (SWL) of kidney stones were randomly divided into two groups to perform SWL in the prone position (40 patients) or conventional supine position (41 patients). Demographic data, stone characteristics, skin–to–stone distances (SSD) in CT, SSD during SWL with an ultrasound probe in prone and supine positions, total shock wave rate, total energy (kilovolt), visual analog scale (VAS), complications (Clavien-Dindo scale system), and SWL success rate evaluated in two intervention and control groups. All statistical analysis was performed by independent T-test, Chi-Square test, Fisher exact test, paired T-test, and SPSS 22.0 software for windows.
Results: There were no significant differences between demographic characteristics, SWL sessions, the median number of SWLs, the median SWL time, median total energy, VAS, and complications in the two groups. The SFR was numerically higher in the prone SWL group than in the supine SWL group (80% vs. 73.2%) but was not significantly different (p-value: 0.468).
Also, the inline ultrasound (US) measuring of the SSD in the prone position was significantly different from US SSD measures in the supine position in the two groups (p-values=0.001 and 0.024). The mean SSD was lower in the US measurement during the SWL process that measured in supine and prone position than the CT measurement (73.5 vs. 101.1), which means the routine SSD measured by CT scan is higher than SSD in the US probe measurement during SWL.
Conclusion : The prone position SWL modification could be effective in obese patients with a BMI of more than 30 and increase the stone-free rate (p-value=0.039) with a similar safety profile and comparable VAS score. It seems the SSD measured by the ultrasound is a more accurate dynamic measurement during the SWL and needs to define the SSD according to the SSD calculation by the US probe of the therapy head. SFR was numerically higher in the prone compared with the supine treatment groups
- Skin-to-Stone Distance; Shock Wave Lithotripsy; Supine position; Prone position
How to Cite
References
Turk C, Skolarikos A, Neisius A. Treatment algorithm for renal stones in disease management on urolithiasis; EAU guideline. 2019.
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: American urological association/endourological society guideline, PART I. The Journal of urology. 2016;196(4):1153-60.
Kekre NS, Kumar S. Optimizing the fragmentation and clearance after shock wave lithotripsy. Current opinion in urology. 2008;18(2):205-9.
Aghamir SMK, Salavati A, Hamidi M, FallahNejad A. Primary Report of Totally Tubeless Percutaneous Nephrolithotomy Despite Pelvi-calyceal Perforations. Urology journal. 2017;14(4):4020-3.
Jenkins AD, Gillenwater JY. Extracorporeal shock wave lithotripsy in the prone position: treatment of stones in the distal ureter or anomalous kidney. The Journal of urology. 1988;139(5):911-5.
AFSHAR ZA, Elahian A, Ghorbani N, Tavoosi A. Extracorporeal shock wave lithotripsy in prone and supine positions for patients with upper ureteral calculi. 2006.
Abouelleil M, Chelluri R, Daugherty M, Bratslavsky G, Shapiro O. In Obese Patients, the Distance Between Skin and Renal Collecting System Changes with the Position of the Patient from Supine to Prone. Journal of endourology. 2015;29(7):760-3.
Wagenius M, Oddason K, Utter M, Popiolek M, Forsvall A, Lundström K-J, et al. Factors influencing stone-free rate of Extracorporeal Shock Wave Lithotripsy (ESWL); a cohort study. Scandinavian Journal of Urology. 2022;56(3):237-43.
Zia H, Khatami F, Rahimi MR, Aghamir SMK. Combined Direct Visual and Imaging Guided Percutaneous Nephrolithotomy: A Novel Technique. Translational Research in Urology. 2021;3(1):4-9.
Choi JW, Song PH, Kim HT. Predictive factors of the outcome of extracorporeal shockwave lithotripsy for ureteral stones. Korean journal of urology. 2012;53(6):424-30.
Jafari Shahdani MR, Fattahi B, Mohseni MG, Aghamir SMK. Comparison of Mini-perc and Retrograde Intrarenal Surgery in Residual Stone Fragments with Hounsfield Unit after Percutaneous Nephrolithotomy. Translational Research Urology. 2021;3(2):40-4.
Ray AA, Ghiculete D, D'A. Honey RJ, Pace KT. Shockwave lithotripsy in patients with horseshoe kidney: determinants of success. Journal of endourology. 2011;25(3):487-93.
Elkoushy MA, Morehouse DD, Anidjar M, Elhilali MM, Andonian S. Impact of radiological technologists on the outcome of shock wave lithotripsy. Urology. 2012;79(4):777-80.
Fakhr Yasseri A, Hamidi M, Aghamir SMK. Comparison of Stone-Free Rates after Ureteroscopic Pneumatic Lithotripsy in Impacted vs. Non-Impacted upper Ureteral Stones. Translational Research in Urology. 2019;1(2):79-83.
Jacobs BL, Smaldone MC, Smaldone AM, Ricchiuti DJ, Averch TD. Effect of skin-to-stone distance on shockwave lithotripsy success. Journal of endourology. 2008;22(8):1623-8.
Zomorrodi A, Elahian A, Ghorbani N, Tavoosi A. Comparison of the effect of body position, prone or supine, on the result of extracorpreal shock wave lithotripsy in patients with stones in the proximal ureter. Saudi Journal of Kidney Diseases and Transplantation. 2007;18(2):200.
Li T, Gao L, Chen P, Bu S, Cao D, Yang L, et al. Supine versus prone position during extracorporeal shockwave lithotripsy for treating distal ureteral calculi: a systematic review and meta-analysis. Urologia internationalis. 2016;97(1):1-7.
Polo MA, Martín MA, Ortiz JM, Gómez AZ. Perforation of ascending colon after extracorporeal shock waves lithotripsy. A review of the literature. Actas Urologicas Espanolas (English Edition). 2010;10(34):920-1.
Guntekin E, Kukul E, Kayacan Z, Baykara M, Sevuk M. Morbidity associated with patient positioning in extracorporeal shock wave lithotripsy of distal ureteral calculi. International urology and nephrology. 1994;26(1):13-6.
Göktaş S, Peşkircioğlu L, Tahmaz L, Kibar Y, Erduran D, Harmankaya Ç. Is there significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithotripsy? European urology. 2000;38(5):618-20.
Ossandon E, Recabal P, Acevedo C, Flores JM, Marchant F. The lithotripsy table height: a novel predictor of outcome in shockwave lithotripsy. International braz j urol. 2011;37(3):355-61.
Ziaee SAM, Hosseini SR, Kashi AH, Samzadeh M. Impact of sleep position on stone clearance after shock wave lithotripsy in renal calculi. Urologia Internationalis. 2011;87(1):70-4.
Karatzas A, Gravas S, Tzortzis V, Aravantinos E, Zachos I, Kalogeras N, et al. Feasibility and efficacy of extracorporeal shock-wave lithotripsy using a new modified lateral position for the treatment of renal stones in obese patients. Urological research. 2012;40(4):355-9.
Cakiroglu B, Sinanoglu O, Akgün FS, Arda E, Yuksel I, Akdere H. Does mild hydronephrosis induced by full-bladder improve outcomes in patients undergoing shock wave lithotripsy for lower calyceal stones?: A prospective randomized study. Urology journal. 2018;15(3):92-5.
Lu J, Sun X, He L. Sciaticum majus foramen and sciaticum minus foramen as the path of SWL in the supine position to treat distal ureteral stone. Urological research. 2010;38(6):417-20.
Hara N, Koike H, Bilim V, Takahashi K, Nishiyama T. Efficacy of extracorporeal shockwave lithotripsy with patients rotated supine or rotated prone for treating ureteral stones: a case-control study. Journal of endourology. 2006;20(3):170-4.
Ahmed A-f, Shalaby E, Maarouf A, Badran Y, Eladl M, Ghobish A. Diuresis and inversion therapy to improve clearance of lower caliceal stones after shock wave lithotripsy: A prospective, randomized, controlled, clinical study. Indian journal of urology: IJU: journal of the Urological Society of India. 2015;31(2):125.
Leong WS, Liong ML, Liong YV, Wu DB-C, Lee SWH. Does simultaneous inversion during extracorporeal shock wave lithotripsy improve stone clearance: a long-term, prospective, single-blind, randomized controlled study. Urology. 2014;83(1):40-4.
Bohris C, Stief CG, Strittmatter F. Improvement of SWL efficacy: reduction of the respiration-induced kidney motion by using an abdominal compression plate. Journal of endourology. 2016;30(4):411-6.
Kang JH, Lee SW, Moon SH, Sung HH, Choo SH, Han DH. Relationship between patient position and pain severity during shock wave lithotripsy for renal stones with the MODULITH SLX-F2 lithotripter: a matched case-control study. Korean journal of urology. 2013;54(8):531-5.
- Abstract Viewed: 0 times
- Just Accepted-7418 Downloaded: 0 times